CVSURN

I thought I would post this here to see what you smart guys/gals thought of the situation. Hello, I am a CVSU RN in a small hospital with about 11 beds in our unit. We have two heart surgeons who pretty much do it all, including the pulmonary, GI, and renal stuff. Very rarely do they like to consult another doctor. I have an RN friend who works on the unit with me, and her 50 year old father just found out he had a heart attack, and his ejection fraction is only 15%. He has had no symptoms at all. No chest pain or shortness of breath. he walked a 3 mile turkey hunt without difficulty at all. He has been a little fatigued over the past couple months, but that is it. He quit smoking two weeks before he found out. He was chewing on a nicorette gum one day, and passed out. He had the workup, echo, cath, etc. Her father has severe multi vessel disease, with a 100% occlusion of his LAD, and 3 separate 80-90% occlusions of his RCA. He had good collaterals off of his RCA which is probably why he is still alive. They refused to to PTCA on him, and they've refused to operate on him for now. They want to treat him medically, and then MIGHT operate on him in a few weeks when his heart is stronger. Again I reiterate he has had no symptoms. He does have a few risk factors:smoker, hi cholesterol, familial history. He's a great man. Just wondering if anyone had any new ideas on what can be done for him besides an operation? Should we take a chance and have someone PTCA that LAD? On our unit, as I said the surgeons do it all. It is a small hospital. We don't use an intensivist for any of the medical care. the surgeons do it. They're always reluctant to consult another doctor. Sometimes it has devastating results. Should her father go to another facility for an operation if needed? Anybody feel indifferent about having heart surgery at a smaller facility? Also we both work there, and it would be extremely difficult for either one of us to take care of him. This is a whole other situation. How would you feel about taking care of a very critically ill father of a friend and co-worker? Personally I don't want to do it, but I feel i may have to. My friend is also angry at her father for treating himself badly all these years because now he may die and leave them alone. She just doesn't know how to express that anger. What would you tell her? Thank you in advance. I just wanted to get the advice of some other nurses out there. I am new to the board. Thanks a lot.

No, He has no symptoms at all, trust me. I have been around him for a decent amount of time, especially since this happened. He has felt a little fatigued over the last couple of months, but everyone knows fatigue can be anything. What upset my friend so much about it is that he has never had any symptoms,or any of the telling signs that he was having heart trouble. No Chest pain, no edema, no abn. wt. gain. And now, he is suddenly on the edge of dying. It's not easy. Hell, the day before he passed out, he walked a 3 mile hike turkey hunting without any chest pain or shortness of breath. I do not believe he is denying symptoms at all. He is a truthful person, and sort of a worrier too. I've agreed with the idea of seeing another heart doc. at a cutting edge facility, and I believe someone might take the chance to PTCA that LAD with his low EF. My theory is to put in an IABP, and then do a PTCA, and if the PTCA goes awry, take him to the OR(what choice would u have really). I'm not sure he would make it through heart surgery, but I don't see many other options. I've also thought about a MIDCABG. The reason to wait is to do a stress test in about 3-4 weeks, and see if his heart is viable enough to undergo CABG. So they're treating him medically for awhile, hoping his heart will get stronger, and they will probably do surgery on him. The surgeon here even said he will have a rough time post-operatively. Personally, I think it will be less rough at a bigger place, where they can get to him quicker if something happens. My friend really likes the surgeon here because she has a personal relationship with him, and the nursing staff also. I feel the opposite sort of whereas I think other factors could hinder the care he is going to get. I believe if a complication arose he would be attended to quicker, and I also think he might get better medical care elsewhere. I just don't know how to convince her of that fact. Any ideas? I've told her about getting a second opinion, and then deciding on what to do, but I don't think she wants to put her father through that. Thanks all for your words. CVSU RN

Hello, I am a CVSU RN in a small hospital with about 11 beds in our unit. We have two heart surgeons who pretty much do it all, including the pulmonary, GI, and renal stuff. Very rarely do they like to consult another doctor. I have an RN friend who works on the unit with me, and her 50 year old father just found out he had a heart attack, and his ejection fraction is only 15%. He has had no symptoms at all. He quit smoking two weeks before he found out. He was chewing on a nicorette gum one day, and passed out. He had the workup, echo, cath, etc. Her father has severe multi vessel disease, with a 100% occlusion of his LAD, and 3 separate 80-90% occlusions of his RCA. He had good collaterals off of his RCA which is probably why he is still alive. They refused to to PTCA on him, and they've refused to operate on him for now. They want to treat him medically, and then MIGHT operate on him in a few weeks when his heart is stronger. Again I reiterate he has had no symptoms. He does have a few risk factors:smoker, hi cholesterol, familial history. He's a great man. Just wondering if anyone had any new ideas on what can be done for him besides an operation? Should we take a chance and have someone PTCA that LAD? On our unit, as I said the surgeons do it all. It is a small hospital. We don't use an intensivist for any of the medical care. the surgeons do it. They're always reluctant to consult another doctor. Sometimes it has devastating results. Should her father go to another facility for an operation if needed? Anybody feel indifferent about having heart surgery at a smaller facility? Also we both work there, and it would be extremely difficult for either one of us to take care of him. This is a whole other situation. How would you feel about taking care of a very critically ill father of a friend and co-worker? Personally I don't want to do it, but I feel i may have to. My friend is also angry at her father for treating himself badly all these years because now he may die and leave them alone. She just doesn't know how to express that anger. What would you tell her? Thank you in advance. I just wanted to get the advice of some other nurses out there. I am new to the board. Thanks a lot. CVSU RN